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tPA in acute ischemic stroke

United States experience and issues for the future

From the Stroke Acute Care Unit, Duke University Medical Center, Durham, NC.

Address correspondence and reprint requests to Dr. Mark J. Alberts, Stroke Acute Care Unit, Duke University Medical Center, Division of Neurology, Room 227, PO Box 3392, Durham, NC 27710.

Abstract.

The approval of tissue plasminogen activator (tPA) for treatment of patients with ischemic stroke in the United States marked the first therapy proven to reverse or limit the effects of an acute stroke. Despite this approval and the lack of an alternative therapy, the use of tPA in stroke has been quite low. Several explanations for this underutilization have been identified, including lack of patient awareness, potential complications, infrastructure deficiencies, and physician concerns. This article explores these issues and suggests strategies for improving the use of tPA as an acute therapy in stroke.

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